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General NPI Number Information
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NPI Number | 1609259126
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Entity Type | Organization
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Legal Business Name | RAO UPPUULURI, M.D.S.C.
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 17901 GOVERNORS HWY SUITE 202
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City | HOMEWOOD
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State | IL
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Zip | 60430-1144
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Country | US
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Telephone | 708-957-0221
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Fax | 708-957-4519
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Provider Business Mailing Address
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Address Line | 17901 GOVERNORS HWY SUITE 202
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City | HOMEWOOD
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State | IL
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Zip | 60430-1144
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Country | US
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Telephone | 708-957-0221
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Fax | 708-957-4519
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. FRAN M NORRIS
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Credential |
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Telephone | 708-957-0021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085005481
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License Number State | IL
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